So I've been listening to a ton of policy wonk discussions about this pending Repeal and Replace. As of a couple months ago, all had been certain that this would happen once the GOP got control of all branches of government. This was based not just on public GOP stance, but on many of the policy analysts and journalists convos with politicians who were 100% committed to doing away with the law and putting in a better conservative plan.
Now, with all eyes on them and pressure building, these same policy analysts and journalists are becoming MUCH less certain how things will go. Their consensus is that the GOP rank and file (ie, regular Senators and Congresspeople who were not involved in crafting the handful of alternative plans that are currently floating around) never paid much attention to 1) exactly what the ACA was and how it was currently working (ie they didn't really understand the law they were against); 2) what was popular and unpopular about the law; 3) what the conservative alternatives involved.
In other words, most GOP politicians just kept hearing from their most rabid base "law is evil and everyone hates it, repeal it or we will vote you out" and from senior members "law is evil, and we have a much better conservative plan". And they took all this on faith and happily carried water for this message.
But now, with the reality staring them in the face, a lot of them have actually started looking in detail at the law they are about to do away with, and looking at the supposed alternatives being proposed by the GOP leadership. And they are starting to hold public hearings to find out what people truly like and dislike.
And guess what? People do indeed dislike some parts of the law (the mandate, the often high deductibles, the limited plan options in some parts of the country) and that's fine, since the GOP also dislikes those things. But the public LOVES a few parts of the law (preexisting condition coverage, kids on parents plans, mandated coverage of preventative care, etc). Unfortunately for the GOP rank and file, they are now looking at their alternative plans and finding that the 'conservative' options mostly are fundamentally based around increasing the things that people most dislike about the current law, while simultaneously not having a workable funding mechanism to allow inclusion of the things people really LIKE.
During the discussions I've heard, one policy analyst compared it to the crash and burn of W's Social Security privatization scheme within his own party. That occurred for basically the same reason: rank and file took it on faith for years that privatization was sooo much better than current SS. But when they actually had to sit down with the proposals and pay attention to the details, they suddenly realized that to make privatization work they had to somehow come up with trillions of dollars to cover the gap for paying for the current SS recipients (because privatization would take all those contributions away and put them in the ownership of the current workers), they all freaked out and had no appetite for paying for that gap. Hence, the scheme went dead in the water almost immediately.
Something similar seems to be churning up now. In addition to this, the GOP governors of the states that accepted the Medicaid expansion are also starting to make noise and put pressure on their Congresspeople about 1) losing the federal Medicaid money, and 2) the fact that they will be on the front lines dealing with the millions of poor people who will lose coverage under the existing GOP plans.
Add to this the fact that Trump ran on making sure everyone stayed covered for less money, and on not touching Medicare/Medicaid, and also the fact that Trump keeps insisting that repeal and replace will happen simultaneously (which is giving Ryan, McConnell et al. fits because they would never promise that and would much rather 'Repeal and Delay' until after the mid-terms) and now the future of this repeal is very uncertain.
Further, here is a truly deadly possibility: what if the GOP repeals and replaces, and the GOP healthcare law fails or proves unpopular? The GOP knows that the story will then be, well, we tried the Dems version of private health care insurance reform, and we tried the GOPs version of private health care insurance reform, and guess what the next option is? Single payer! And the GOP will do almost anything to avoid that storyline.
So....There is now a decent chance developing that the GOP will have to "repeal" the law in name only, keep nearly all of it intact, tinker to fix the things that aren't working very well (which is what the Dems have been pushing all along), rename it Trump-care or Ryan-care or whatever, and continue on their merry way patting themselves on the back for their awesome health care plan.
Which, given that this WAS originally the GOP's awesome heath care alternative back in the 1990s, would be very ironic.
